Uche Amazigo, PhD

World Health Organization, African Program for Onchocerciasis Control

Uche Amazigo comes from humble origins, but this daughter of a Nigerian chauffeur earned a doctorate in public health and is working with the World Health Organization on the challenge of controlling onchocerciasis, widely known as river blindness. When she arrives in her client villages in rural Africa, she carries out a complex diplomat's role. A striking and elegant figure in her traditional robes, she must command the attention and respect of both village leaders and community volunteers alike if she is to persuade them of the importance of taking their medicine.

"The people that have river blindness are the poorest of the poor," Amazigo explains. "They live far from the cities, and they're beyond the end of the road. Most of them live 50 kilometers away from the end of the tarred routes."

In the mountainous river valleys of Togo, West Africa, there's a saying that "the river eats your eyes." Biting black flies breed in the fast-flowing river and infect their human victims with parasitic larvae. These larvae grow into adult worms, producing millions of tiny offspring that course through the human body and cause unbearable itching. Eventually, the worms damage the eyes to the point where people become permanently blind.

River blindness affects 12 African nations, and in some communities, 15 percent of the population is blind, with up to 40 percent of adults visually impaired.

Merck & Co. (The Merck Company Foundation is a funder of the Rx for Survival project) developed a medicine called Mectizan which, when taken just once a year, can prevent river blindness. In 1987, Merck's CEO, Roy Vagelos, stunned the world by announcing that Merck would donate Mectizan free of charge to affected countries for as long as it was needed. But the logistics of giving away the drug were daunting, and Merck enlisted the help of the World Health Organization, The Carter Center, and a consortium of aid agencies. Soon mobile teams of health workers fanned out across Africa to deliver the drug to every far-flung village.

But the agencies soon found that these arduous journeys could not be made every year; the task was simply too enormous. Amazigo and her team were stymied: "We needed a low-cost and sustainable strategy. We asked ourselves one question: Can the communities themselves distribute this drug?"

Amazigo devised a plan to train volunteers to distribute the medicine in their local villages, and to take it by foot or bike to the most isolated farms. Mectizan has now been distributed by such means to more than 40 million people in 34 countries and to more than 60,000 villages worldwide. Amazigo knows she and the volunteers must keep up their efforts to maintain the progress made so far. "If we still leave people harboring these worms," she says, "the flies will pick up the worms from those that are infected. We cannot stop now, because the disease will come back."

For now the program is working very successfully, but it's critical to eliminate the threat of river blindness as soon as possible so the disease does not take hold again. Health workers with the confidence and resolve of Uche Amazigo will be needed to eradicate it entirely and make river blindness — like smallpox — a scourge of the past.